bookpower Chapter 359
Chapter 359
That's right
In addition to the above possibilities,
There is also a possibility:
Gastric cancer!!
Because the patient in front of him, in his sixties, the possibility of stomach cancer is still very high.
Next, there is the diagnosis, which is eliminated one by one.
The first is esophageal cancer:
This consultation can not be asked, generally to "swallow barium X-ray double contrast angiography"...
Then fish bones, foreign bodies.
"Have you eaten fish lately?" Or swallowed something that shouldn't? Half a month, a month..."
"No, this definitely not, I am most afraid of eating fish, I was stabbed when I was young, and I never ate fish with bones again... As for the other foreign bodies, there are definitely not..."
Lin Feng nodded.
Temporarily exclude fish bones, foreign bodies, puncture blood vessels...
Continue to the next item: ulcers in various parts of the upper digestive tract, stomach cancer.
"Do you usually have abdominal pain, nausea, acid reflux, bloating and other discomfort?"
If there is, then it is suspected that stomach ulcer and duodenal ulcer may be possible, because these diseases usually have these discomforts, and hematemesis is only one of the manifestations.
Outcome......
Old Liu shook his head repeatedly:
"No, no, no... I've always been fine, what nausea, discomfort, I haven't tried..."
Lin Feng: ".................."
Temporarily rule out ulcers, stomach cancer...
The last item,
Cirrhosis.
"Have you ever had hepatitis before, such as hepatitis B, cirrhosis and so on... Medical history? "
In fact, when asking this sentence, Lin Feng probably ruled it out.
Because patients with cirrhosis of the liver are generally fatigued, emaciated, and dull.
The patient in front of him, Lao Liu, in addition to being a little pale, is actually healthy, mental, and slightly fat...
I don't want cirrhosis no matter how you look at it.
Sure enough, the patient Lao Liu shook his head: "I don't have these... When my son got me a group medical examination last year, everything was normal..."
Lin Feng: "???? "
This does not,
That's not either.
So what exactly is the reason?
"How about I give you a gastroscope?"
"What is a gastroscope?"
Lin Feng patiently explained: "Since you said that it is vomiting blood, it should be a problem of the digestive tract, but your answer just now makes me a little confused, so, I want to make you a gastroscope, insert the mirror from the mouth, and see if there is any problem with the esophagus, stomach, and duodenum..."
Mirror......
Insert it into the stomach?
When he heard this, the patient Lao Liu was frightened on the spot.
"No, no, no, I don't want to do gastroscopy..."
"Why?"
"It hurts..."
"Don't be afraid, you can choose the painless, give anesthesia, and then extend the gastroscope into it..."
Even though Lin Feng said this, the patient Lao Liu still shook his head repeatedly.
Resolutely refused.
"Don't do it, don't do it..."
Lin Feng: "..........................."
Seeing patients like this, I really don't want to.
As a doctor, you need to ask for the patient's consent for everything, otherwise it is easy to cause medical disputes.
So Lin Feng would not force the patient to do this...
Since the patient resists gastroscopy, think of other ways.
The patient vomited blood, which would definitely bleed profusely at any time, then go into shock, and then die.
So the inspection must not be delayed!
Lin Feng thought for a while: "Otherwise, let's do an angiogram for you..."
Then, Lin Feng introduced angiography.
"This can, this can!"
The patient Lao Liu only needs to punch a hole in his arm and send a catheter in, and he doesn't even need large-scale anesthesia...
Simply wonderful.
"That's it, Image!"
Lin Feng: "Before doing the angiography, I want to tell you about its shortcomings: first, it will have certain side effects on the kidneys, of course, it is also controllable, and second, it may not be able to find bleeding." "
Because Lin Feng looked at the patient in front of him, Lao Liu, he is currently in good condition, he has not vomited, and the bleeding port may have stopped the bleeding on its own (but in fact, it is still dangerous, a time bomb, and it explodes at any time).
In this case, angiography may not be able to find a bleeding port.
"I decided, that's it..."
This patient Lao Liu should have some money, and would rather spend money than do gastroscopy."
Lin Feng: "Okay, I'll arrange it..."
......
After 20 minutes,
The patient was pushed to the interventional department, angiography was carried out ...
It took 20 minutes...
The imaging results are out!
・ No bleeding port found! Nothing!
Lin Feng was disappointed: "Liu Bo, in your situation, you still have to continue to do gastroscopy..."
Patient Lao Liu: ".................."
He really didn't want to do a gastroscope himself!
The older you get, the more stubborn you are...
Wait a minute......
At this time, Lin Feng thought of another possibility.
"Nosebleed"!
The nasal cavity, the front end is the nostrils, and the back end is the throat.
(King Kong beautiful boy to brother nasopharyngeal swab ·jpg)
It is possible that nasal bleeding, flowing backwards to the throat irritating nausea, and then vomiting out!
"I'll look at your nose..."
Lin Feng flashed a flashlight and observed the nostrils of the patient Lao Liu...
No traces of blood were found.
But
It is possible that the bleeding is deeper.
"I'll make you a nasopharyngeal scope..."
This is a medical device that examines the nasopharynx, throat, and larynx, performs biopsy, surgical treatment of vocal cord nodules or small vocal cord polyps, and removes pharyngeal foreign bodies.
Technology: fiber + microscope...
If Liu Lao really has a nosebleed, even if it is not active bleeding, the clues can still be seen through the endoscope.
"Nose? No problem..."
This time, the patient Lao Liu did not refuse.
......
After 10 minutes,
Old Liu covered his tearful eyes, his expression sour...
·「 Nasopharyngoscopy" Result: No bleeding!!
Nosebleeds were excluded.
Now,
Things eventually turned back to the "gastroscope".
gastroscope
became the only means.
Just then...
The patient Lao Liu suddenly began to vomit blood.
"Ahem~~~~"
"Ka~~~~"
"Bah! Bah! Bah! "
Then, several clouds of blood, like spitting, were spit out by him and quickly caught by the nurse with a spittoon.
Lin Feng who saw this scene,
Directly covered my face!
"Shit vomiting blood!"
Ten thousand grass and mud horses in the heart rushed by!
This is not vomiting blood at all!
Real hematemesis refers to vomiting with blood caused by bleeding in the esophagus, stomach and intestines, and that kind of action will be more violent, and it is definitely not so easy to vomit.
This is vomiting blood, not vomiting blood, and certainly not coughing up blood!!
Misled by this old Liu!
This old Liu is definitely not the digestive tract, nor the airway, but the ———— mouth!!
Definitely bleeding from the mouth, reflux, and then just like phlegm, coughing it out!!
"Open your mouth, I'll see... Ah~~~"
"Ah~~~"
Although Lao Liu was a little puzzled, he still opened his mouth very cooperatively.
.